Root Canal Length Determination Research Articles

An Ex-Vivo Study Comparing the Accuracy of the E-Connect S+ and Morita Tri Auto ZX2+ Endodontic Handpieces in Root Canal Length Determination

IntroductionThis ex vivo study evaluated the accuracy of the Electronic Apex Locator (EAL) and Automatic Apical Stop (AAS) functions of the E-Connect S+ and Morita Tri Auto ZX2+ cordless apex locators in determining patency length. MethodsSixty-four human teeth with a single root were randomly allocated into E-connect or Morita groups (n = 32). The canals were accessed and preflared, after which a size 15 K-file was inserted into the canal to the major foramen and recorded as the actual length (AL). Matched measurements were taken using the AAS and EAL functions and visually confirmed with confocal microscopy. The variance between canal length (mm), the persons correlation (ρ) between function and AL, and the accuracy (%) of the canal length relative to the AL (Δmm) between devices and functions were assessed. ResultsRegardless of device or function, all measurements were within 1±Δmm and correlated strongly (ρ > 0.97) with the AL. When considering a more stringent clinically acceptable range of 0.5±Δmm from the AL, all devices and functions demonstrated similar accuracy levels (84%–94%). However, at lower tolerance ranges, the E-connect device with the EAL function exhibited the highest accuracy. On average, all devices and functions stopped short of the AL (mean Δmm>0). ConclusionThe E-Connect S+ and Morita Tri Auto ZX2+ apex locators provided reliable accuracy in determining the position of the major foramen. These findings demonstrate a high level of reproducibility in canal length measurements using both cordless endodontic handpieces, regardless of whether the EAL or AAS functions were employed.

Effects of CBCT acquisition protocol and additional superimposed computerized optical impressions on the accuracy of root canal length measurements: an ex vivo study.

The purpose of this investigation was to evaluate the accuracy of root canal length determination in dependence of CBCT acquisition protocol and evaluating the influence of additional superimposed computerized optical impressions. CBCT scans with low-dose (LD) and high-definition (HD) protocols and computerized optical impressions of thirty extracted human molars were acquired. The Sicat Endo software (Sicat, Bonn, Germany) was used for CBCT root canal length (RCL) measurements with (LD+, HD+) and without (LD-, HD-) a superimposed optical impression. To evaluate the accuracy, absolute differences between test groups and the actual root canal length (ARCL) were calculated and statistically analyzed using the Wilcoxon-Rank-Sum-Test. Absolute differences between the ARCL and the tested measurement methods varied significantly (p<0.05). Both, higher resolution and additionally superimposed computerized optical impression improved measurement accuracy. Mean differences compared to the ARCL were 0.26 mm (HD+), 0.34 mm (HD-), 0.43 (LD+) and 0.66mm (LD-). 93.4% of all measurements in the HD+ group were within the limits of ±0.5 mm. Both resolution and superimposition of additional computerized optical impressions have a significant influence on root canal length measurements using CBCT.

Comparative analysis of root canal length determination using cone-beam computerized tomography and apex locator

Introduction. Determining the length of the root canal is one of the key factors that can affect the outcome of endodontic therapy. Incorrectly determined working length results in underfilled or overfilled canal. The aim of this work was to verify the effectiveness of cone-beam computerized tomography (CBCT) and apex locators in determining working length of the root canal. Material and method. Endodontic procedure was performed according to established endodontic protocol on 98 teeth. Teeth were divided into two groups: single-rooted and multi-rooted teeth. In both groups, working length was measured with an apex locator (Woodpex III) and CBCT (Planmeca Viso). In multi-rooted teeth, the canals were classified according to their morphological position into the groups Lingvomesial (LM), Buccomesial (BM), Bucodistal (BD), Palatal (P) and Distal (D) canals. Root canal length was determined by a dentist using apex locator at the University of Banja Luka while CBCT analysis was performed by a radiology engineer at the 3DENT radiology center in Banja Luka. Results. CBCT odontometry had small deviations from apex locator odontometry. The mean value of the absolute difference between CBCT measurement and apex locator measurement was the smallest in the group of linguomesial canals (0.284 mm), and the largest in the group of distal canals of the lower molars (1.939 mm). Based on the results of the Mann-Whitney U test, it was concluded that there was no statistically significant difference (p &gt; 0.05) in measured length of the root canal between the two methods in all groups of roots of multi-rooted teeth as well as in the group of single-rooted teeth. Conclusion. CBCT odontometry is as reliable as apex locator odontometry.

A critical analysis of research methods and experimental models to study working length determination and the performance of apex locators – A narrative review with recommendations for the future

Outcome studies have repeatedly shown that the apical endpoint of root canal preparation and filling is a determinate factor for the outcome of root canal treatment. Accurate determination of root canal length enhances the efficacy of chemo-mechanical disinfection and prevents over-/under-instrumentation and over-/under-filling in relation to the canal terminus. Long and short root canal fillings are consistently reported to be associated with higher rates of post-treatment endodontic disease. Although standards for undertaking and reporting diagnostic accuracy studies are available, publications dealing with the determination of root canal length are highly heterogeneous and describe procedures inconsistently. The aim of this review is to critically assess the methodology of publications in the past three decades. The process of planning, performing and analysing working length studies are presented stepwise with suggestions to optimize research methods.

The Effect of Long Service Life on the Accuracy of Dentaport ZX Electronic Apex Locator.

Electronic apex locators are among the most acceptable instruments for determining root canal length. The present study aimed to evaluate the effect of long service life on the accuracy of the Dentaport Root ZX (DP ZX) electronic apex locator (EAL). In this study, fifty single-rooted freshly extracted human teeth were used. After determining the root canal length with a K-file and a dental operative microscope, the canals were measured with four separate DP ZX apex locators (two with more than 6 years of life service while two others had less than 6 years of life service). Data were analyzed by repeated ANOVA measurement. No significant difference was found between the EALs with different years of life services (P=0.62). All EALs could determine root canal length with high accuracy of more than 94%. Based on the results of this in vitro study, the long service life had no significant impact on the accuracy of DP ZX EALs in terms of root canal length determination.

The Effect of Calcium Hydroxide and File Sızes on the Accuracy of the Electronic Apex Locator in Simulated Immature Teeth

Objective: The aim of this research was to appreciate the effects of different file sizes and the presence of calcium hydroxide on the correctness of the electronic apex locator (EAL) at simulated immature teeth. Methods: In this study, 30 maxillary central teeth were used beforehand extracted due to periodontal reasons. The actual root canal length determined with K-File and measured behind 0.5mm from the apex. In order to simulate an immature tooth, the apical of roots were prepared with a diameter of 1,4mm Gates-Glidden drills and K-Files. Working lengths of samples were measured using the Root ZX by 110-140 K-Files. Each measurement was repeated three times and averaged. Then all the samples were filled with calcium hydroxide medicament and working lengths were determined by the same method. Statistical analysis was performed using the Two-way ANOVA. Results: The measurements were closer to the actual root canal length as the diameter of the file increased at the presence and absence of calcium hydroxide. However, there was a difference between the presence and absence of calcium hydroxide in the determination of root canal length. Conclusions: In these experimental study conditions, it was concluded that the presence of calcium hydroxide in simulated immature teeth and file size affect the EAL.

Accuracy of Four Electronic Apex Locators During Root Canal Length Determination

Accuracy of Four Electronic Apex Locators During Root Canal Length Determination

Comparing the accuracy of cone-beam computed tomography and electronic apex locator for root canal length determination in primary teeth

Comparing the accuracy of cone-beam computed tomography and electronic apex locator for root canal length determination in primary teeth

A Micro–computed Tomographic Evaluation of the Accuracy of 3 Electronic Apex Locators in Curved Canals of Mandibular Molars

IntroductionThis study evaluated the accuracy of 3 electronic apex locators (EALs) (CanalPro [Coltene-Endo, Cuyahoga Falls, OH], Apex ID [SybronEndo, Glendora, CA], and Root ZX Mini [J Morita, Tokyo, Japan]) in curved mesial canals of extracted mandibular molars using micro–computed tomographic (micro-CT) scanning. MethodsThe root canal length and the actual working length of 58 canals were measured using the visual method and 3-dimensional micro-CT reconstructions. The measurements of the EALs at marks “APEX/0.0” and “0.5 mark” were recorded as the electronic root canal length and the electronic working length, respectively. The absolute mean values and the percentages of distribution of the electronic measurements were compared with the actual lengths of the canals. The presence of isthmuses, accessory canals, foramen position, and the distance between the apical constriction and the apical foramen were recorded from the micro-CT scans, and their correlation to the accuracy of the EALs was determined. ResultsAll electronic measurements showed high agreement with their respective gold standard, except the electronic root canal length of the Apex ID (P < .05). No difference in the percentage of precise measurements (within the ±0.5 mm) was found among the devices (χ2 and z tests, P > .05). Of the anatomic parameters evaluated, the presence of a lateral foramen negatively affected the 0.0 mark of the Apex ID (Wilcoxon test, P < .05). ConclusionsThe Root ZX Mini and CanalPro were precise for both root canal length and working length determination in mesial curved canals of mandibular molars, whereas the Apex ID was accurate for the working length when using the 0.5 mark.

Accuracy and consistency of electronic root canal length determination with electrically isolating rubber stoppers.

The aim of this study was to investigate the influence of an isolating silicone stopper on the measuring accuracy and display consistency of three electrometric apex locators. The length of the canal to the major foramen was determined electrometrically using an ISO size 10 file in 20 extracted teeth each with natural crowns (Group I), amalgam fillings (Group II) or base-metal crowns (Group III), The measurements were performed with isolating or conventional silicone stoppers using three different apex locators with a four-level scale consistency rating. The use of isolating stoppers resulted in a more consistent display than with conventional stoppers, independent of the presence or type of coronal restoration (P = 0.017). Across all coronal restorations, the position of the major foramen could be determined to within ± 0.5 mm without significant differences (P = 0.79) using conventional and isolating stoppers. The use of modified isolating stoppers provides a significant increase in display consistency.

A survey on working length determination of endodontic treatment

The purpose of this study is to evaluate the preferred method of root canal length determination and the apical limit for canal instrumentation among endodontic teachers of dental school. A questionnaire on the preferred method of root canal length determination and the apical limit for canal instrumentation was designed and distributed to endodontic teachers of various dental schools. The response rate was 90%. The most preferred method of root canal length determination was Electronic apex locator (EAL)(89%). The most favoured apical limit for canal instrumentation was 0.5 to 1.0 mm short of the radiographic apex(78%). The most preferred method of using EAL was that the working length is taken at 'APEX' mark and then distracted 0.5mm from that length.(41%). When there is no agreement between radiographic measurement and EAL measurement, 74% of respondents chose the length of EAL measurement. The majority of endodontic teachers from Korean dental schools preferred EAL to radiograph method in determining root canal length.

A smart rotary technique versus conventional pulpectomy for primary teeth: A randomized controlled clinical study.

BackgroundTechniques with adequate accuracy of working length determination along with shorter duration of treatment in pulpectomy procedure seems to be essential in pediatric dentistry. The aim of the present study was to evaluate the accuracy of root canal length measurement with Root ZX II apex locator and rotary system in pulpectomy of primary teeth.Material and MethodsIn this randomized control clinical trial complete pulpectomy was performed on 80 mandibular primary molars in 80, 4-6-year-old children. The study population was randomly divided into case and control groups. In control group conventional pulpectomy was performed and in the case group working length was determined by electronic apex locator Root ZXII and instrumented with Mtwo rotary files. Statistical evaluation was performed using Mann-Whitney and Chi-Square tests (P<0.05).ResultsThere were no significant differences between electronic apex locator Root ZXII and conventional method in accuracy of root canal length determination. However significantly less time was needed for instrumenting with rotary files (P=0.000).ConclusionsConsidering the comparable results in accuracy of root canal length determination and the considerably shorter instrumentation time in Root ZXII apex locator and rotary system, it may be suggested for pulpectomy in primary molar teeth. Key words:Rotary technique, conventional technique, pulpectomy, primary teeth.

Electronic Apex Locators —A Review

The establishment of a correct working length is one of the fundamental parameters for endodontic success. Traditionally this has been determined using radiography, but electronic apex locators are increasingly being used. Electronic apex locators reduce the number of radiographs required and assist where radiographic methods create difficulty. The use of an electronic apex locator in combination with the radiograph is greater precision in the determination of root canal length. The aim of this paper is to review the electronic determination of the length of the root canal.

Performance in vitro of apex locators in determining root length in primary molars

ABSTRACT Objective: The aim of the study was to evaluate performance of digital radiographic and two electronic apex locators, Propex II and Root ZX in root canal length determination in primary molars. Methods: 25 primary molars were divided into two groups, G1 without root resorption and G2 with root resorption. The exams were performed using all methods by two experienced examiners, with 1-week interval. The gold standard was determined by visual examination. The methods were statistically analyzed regarding the values of reproducibility and correlated with the gold standard by Pearson´s correlation coefficient. Results: The root canal length determination coincided with gold standard in 22.7% for Root ZX, 17.5% for Propex II and 12.5% for digital radiography. Correlation values were higher in G1, the Root ZX presented the highest values. In G2 the digital radiography showed the lowest correlation. In G1, the intra-examiner reproducibility values ranged from 0.925 to 0.523, and interexaminer 0.863 to 0.670. In G2, the values of intra-examiner reproducibility ranges from 0.864 to 0.097, and inter was 0.774 to 0.379. Conclusion: It was concluded that the methods performance varying according to examiner's experience. The Root ZX presented the highest reproducibility and accuracy.

Predetermination of root canal lengths in molar teeth: A comparison between radiovisiography and two-dimensional and three-dimensional measurements using cone-beam computed tomography.

Introduction:Obtaining a correct working length is critical to the success of endodontic therapy. The aim of this clinical study was to compare the effect of working length determination using radiovisiography (RVG) and two-dimensional (2D) and three-dimensional (3D) measurements using cone-beam computed tomography (CBCT).Materials and Methods:Thirty mandibular teeth were taken and three groups of 10 each were made. Teeth with previous endodontic treatments, metal restorations, resorptions, incomplete apex formations, and multiple visible foramina were excluded. The root canal length was determined using RVG, CBCT measurement method 2D, and CBCT measurement method 3D. The difference between CBCT measurements, RVG, and the actual canal length were compared to evaluate the accuracy of each method.Results:No significant statistically difference was seen with 3D measurements and actual measurements. Measurements with RVG were better than CBCT 2D.Conclusion:Under experimental conditions, CBCT 3D measurements are accurate than RVG and CBCT 2D in the determination of root canal length.

Clinical evaluation of apex locator and radiography in primary teeth

The aim of this in vivo study was to evaluate the accuracy and reliability of electronic apex locater and radiographic determination of root canal length in primary teeth. A total of 32 human primary molar teeth (96 roots) were selected. After endodontic access preparation, root canals were irrigated with physiological saline solution. The access cavities were dried with cotton pellets and, the roots were dried with paper points before performing the electronic measurement. The root canal length measurements were first taken with an apex locater (EndoMaster), and then, a size ♯ 15 K-file was inserted into the root canal, and radiography was taken to determine the working length measurements. The measurement data were recorded and compared by one-way anova and Kruskal-Wallis tests. P < 0.05 was accepted for the significance. The mean values for radiography were 13.23 ± 1.92 mm and for EndoMaster were 13.08 ± 1.77 mm. The accuracy of EndoMaster was 80.2% in correct measurements ±1 mm (P < 0.001). The electronic apex locators could be useful in determining working length and thereby decreasing the need for radiographs and exposure to ionizing radiation in pediatric dental patients.

Cone-beam Computed Tomographic Scans in Comparison with Periapical Radiographs for Root Canal Length Measurement: An In Situ Study

IntroductionThe primary aim of this study was to compare the precision of root canal length determination on cone-beam computed tomographic (CBCT) scans and periapical radiographs (PAs) with the actual root canal length. The secondary aim was to examine the influence of tooth type on root canal length measurements as assessed on CBCT scans and PAs. MethodsIn total, 40 root canals of 33 teeth (molars, premolars, canines, and incisors) out of 5 dentate maxillas of human cadavers were included. Root canal length measurement was performed by a consensus panel (2 examiners) on CBCT scans (3D Accuitomo 170; J Morita, Kyoto, Japan) and digital PAs. After straight-line access opening, a #15 file was fixated in every root canal at the length measured on CBCT scans. All teeth were extracted, and the root canal containing the file was uncovered. Measurements made on images taken with a digital camera (AxioCam; Carl Zeiss, Sliedrecht, The Netherlands) linked to a stereozoom microscope (Stemi SV6, Carl Zeiss) were used as the actual root canal length. ResultsWhen all roots were examined together, it was not clear which method is better for all types of teeth. For root canals of anterior teeth, there was no significant difference between the 2 methods. For root canals of posterior teeth, CBCT images gave results significantly closer to the actual root canal length in comparison with PAs (t value = −1.96; critical value is 1.74 with a significance level of 0.05). ConclusionsRoot canal length measurements of posterior maxillary teeth were more accurate when assessed by CBCT images than PAs.

Electronic apex locator: A comprehensive literature review - Part I: Different generations, comparison with other techniques and different usages

Introduction: To compare electronic apex locators (EAL) with others root canal determination techniques and evaluate other usage of this devices. Materials and Methods: Tooth apex, Dental instrument, Odontometry, Electronic medical, and Electronic apex locator were searched as primary identifiers via Medline/PubMed, Cochrane library, and Scopus data base up to 30 July 2013. Original articles that fulfilled the inclusion criteria were selected and reviewed. Results: Out of 402 relevant studies, 183 were selected based on the inclusion criteria. In this part, 108 studies are presented. Under the same conditions, no significant differences could be seen between different EALs of one generation. The application of EALs can result in lower patient radiation exposure, exact diagnosing of fractures, less perforation, and better retreatment. Conclusions: EALs were more accurate than other techniques in root canal length determination.

Comparison between electronic and radiographic method for the determination of root canal length in primary teeth

There are few researches in literature that mention the use of the apex locator in deciduous teeth and working length is obtained through radiographies. Objective: The purpose of this research was to compare the radiographic and the electronic method to obtain the working length in deciduous molars. Material andmethods: Twelve molar teeth were used. The specimens in the visual method had their root length measured through the passive insertion of a 10 K-file with a silicone stop within root canal until its tip was seen at the apical foramen. The working length was measured through radiographs or using the apex locator Root ZX II. The mean between the examiners was submitted to the variance analysis (ANOVA). Results: Statistically significant differences were found between the visual method and the radiographic method (p &lt; 0.001). There was no significant difference between the working length measurements in visual method and those obtained with the apex locator (p = 0.1319). Conclusion: The apex locator is indicated as a clinical implementation for endodontic treatment in primary teeth.

An in vitro comparison of root canal length determination by DentaPort ZX and iPex apex locators.

Aim:The aim of the present study is to evaluate and to compare the accuracy of two electronic apex locators (EALs): DentaPort ZX and iPex, at a position 0.5 mm short of the apical foramen.Materials and Methods:Thirty single-rooted, mandibular premolar teeth were selected. Standard access cavities were prepared and the actual length (AL) was calculated. The samples were then embedded in alginate and the electronic measurements were determined and recorded.Results:The results obtained showed that in determining the root canal length with a tolerance level of ±0.5 mm, i.e., AL ± 0.5 mm, DentaPort ZX was accurate in 93.3% of the samples and iPex was accurate in 90% of the samples at a position 0.5 mm short of the apical foramen.Conclusion:A strong correlation was seen between the two electronic methods and AL and also in between the two EALs, showing the possibility of their use to measure the root canal length. No statistically significant difference was found between both the apex locators.